Predictors of Plasma DDT and DDE Concentrations among Women Exposed to Indoor Residual Spraying for Malaria Control in the South African Study of Women and Babies (SOWB)
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Citation: Whitworth KW, Bornman RM, Archer JI, Kudumu MO, Travlos GS, Wilson RT, Longnecker MP. Predictors of Plasma DDT and DDE Concentrations among Women Exposed to Indoor Residual Spraying for Malaria Control in the South African Study of Women and Babies (SOWB). Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1307025.
Received: 30 April 2013
Accepted: 20 February 2014
Advance Publication: 21 February 2014
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Background: Few studies have examined predictors of DDT (dichlorodiphenyltrichloroethane) and DDE (dichlorodiphenyldichloroethylene) levels among residents in homes sprayed with DDT for malaria control, to identify exposure reduction strategies.
Methods: This analysis includes 381 women enrolled in The Study of Women and Babies (SOWB) from 2010-2011, from eight South African villages in the Limpopo Province. Indoor residual spraying (IRS) occurred in half of the villages. Questionnaires regarding various demographic and medical factors were administered and blood samples were obtained. Women were classified into three exposure groups by type of residence: unsprayed village (n=175), IRS village in household with a low likelihood of DDT use (non-DDT IRS Household, n=106), IRS village in household with a high likelihood of DDT use (DDT IRS Household, n=100). Multivariable models of natural log-transformed DDT (µg/L) and DDE (µg/L) plasma levels were used to identify predictors for each group.
Results: Median levels of DDT and DDE among women in unsprayed villages were 0.3 (IQR: 0.1, 0.9) and 1.7 (IQR: 0.7, 5.5), respectively. Median levels of DDT and DDE among women in DDT IRS households were 2.6 (IQR: 1.1, 6.6) and 8.5 (IQR: 4.7, 18.0), respectively. In unsprayed villages, women with water piped to the yard, rather than a public tap, had 73% lower DDT (95% CI: -83, -57%) and 61% lower DDE (95% CI: -74, -40%) levels. In DDT IRS households, women who reported taking > 6 actions to prepare their home before IRS (e.g. covering water and food) had 40% lower DDT levels (95% CI: -63, -0.3%) than women who took < 4 actions.
Conclusion: The predictors of DDT and DDE plasma levels identified in this study may inform interventions aimed at decreasing exposure. Among households where DDT is likely used for IRS, education regarding home preparations may provide an interventional target.
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